期刊
EPIDEMIOLOGY
卷 24, 期 4, 页码 516-521出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/EDE.0b013e318294802e
关键词
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资金
- NIH [R01-AI078752, 1-K01-AI-091440-01]
- Medical Research Council [MR/K010174/1, MR/K010174/1B] Funding Source: researchfish
- MRC [MR/K010174/1] Funding Source: UKRI
Background: The role of acute-stage transmission in sustaining HIV epidemics has been difficult to determine. This difficulty is exacerbated by a lack of theoretical understanding of how partnership dynamics and sexual behavior interact to affect acute-stage transmission. We propose that individual-level variation in rates of sexual contact is a key aspect of partnership dynamics that can greatly increase acute-stage HIV transmission. Methods: Using an individual-based stochastic framework, we simulated a model of HIV transmission that includes individual-level changes in contact rates. We report both population-level statistics (such as prevalence and acute-stage transmission rates) and individual-level statistics (such as the contact rate at the time of infection). Results: Volatility increases both the prevalence of HIV and the proportion of new cases from acute-stage infectors. These effects result from 1) a relative reduction in transmission rate from chronic but not acute infectors and 2) an increase in the availability of high-risk susceptibles. Conclusions: The extent of changes in individual-level contact rates in the real world is unknown. Aggregate or strictly cross-sectional data do not reveal individual-level changes in partnership dynamics and sexual behavior. The strong effects presented in this article motivate both continued theoretical exploration of volatility in sexual behavior and collection of longitudinal individual-level data to inform more realistic models.
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